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Thread: crazy rx,s

  1. #1
    opti-tipster harry a saake's Avatar
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    crazy rx,s

    Today a women walked in with an rx from an OD in California, odd thing about it is there is a printed statement on the rx (not handwritten), stating..DISPENSER DO NOT FILL UNLESS PREPARED TO REMAKE FOR PATIENT COMFORT, anybody ever seen this before, sounds nutty to me:hammer:

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    Not that exact wording, but yes. Have seen "By filling this prescription the optical dispenser agrees to any re-makes required." Along with other nonsensical wording that more or less implies that if the Rx is filled anywhere other than the prescriber's shop, the prescriber isn't responsible for a thing.
    Last edited by chip anderson; 01-25-2005 at 08:44 PM. Reason: Lousy spelling

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    Rising Star
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    also point out to the patient that the dr that wrote the rx has no confience in his/her work. If he has to worry about redos tell them to find another dr.

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    That Boy Ain't Right Blake's Avatar
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    Such disclaimers come in all kinds of flavors. I even saw one that stated "most reputable opticalshops will do remakes at no charge". Thus, if you balk at paying forthe MD's mistake, the customer will wonder if you are "reputable".

    These disclaimers are illegal, unethical and just plain annoying -but... creating ill will from docs who send a lot of patients your way(if unwillingly) by reporting them is also a huge PITA.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Honest to God Doctor's Rx!

    Twenty plus years ago I worked in Boston and was given an Rx to fill from a well known MD.
    O.D. +0.125 -0.125 x 175
    O.S. +0.125 -0.125 x 177 and a 1/2

    It was the 1/2 degree that had the office rolling on the floor in laughter :)

    Also in those days it wasn't unusual to have hungry OD's in the big city offer "vision training" Rx's; here's another!

    O.U. plano distance with 3 prism degrees Base Up O.U.

    Now before all you experienced Doctors jump down my throat we all know the first Rx is someone who comes into the office convinced they need prescription glasses! So who are we to deny them? From my conversation with the second patient I'm not so sure the Doctor wasn't drumming up business.

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    Master OptiBoarder Jedi's Avatar
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    Great timing for this thread.
    Today I recieved a Rx that had a disclaimer on the bottom
    paraphrased "dispenser filling rx must be willing to change lens and/or power to accommodate patients best visual needs".
    "Well Mr.Jones looks like your a half diopter low, shall I filler up?"

    I will try and get the exact wording, but thats the jist of it.
    "It's not impossible. I used to bull's-eye womp rats in my T-16 back home."


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    Quote Originally Posted by Uncle Fester
    O.U. plano distance with 3 prism degrees Base Up O.U.
    FYI: It's my understanding that yoked prisms aren't that uncommon in developmental optometry circles, and I've read different things about them being used for patients with brain injuries, autism, etc.

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    Quote Originally Posted by Blake
    These disclaimers are illegal...
    I, too, thought they were recently made illegal here in California. This evening I looked up the "Laws Relating To The Practice Of Optometry" on the California Board of Optometry's website* but couldn't find anything.

    *This pdf is 254 pages long, so don't bother clicking the link unless you are really interested: http://www.optometry.ca.gov/laws_regs/2001lawbook.pdf

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    Many, many moons ago..

    When I was 21, I changed jobs. The dispensary that I went to work for and now own the remnants thereof was owned by a group of OMD's. In fact that dispensary was part of the lawsuit that resulted in the "Common Roof Law" that got the doctors out of the dispensary owning business unless they "shared a common roof." One slow day I was going through some old record and found Rx's for things like +.12 x 180 (this for a pair of welding goggles) and lots of like stuff. Also found CTD's and was told this ment "Charge to Doctor." In other words when the doctors owned the dispensary themselves, the cost of mistakes was charged back to the individual doctor's account. God forbid that the other doctor's involved should share in the cost of one thier mistakes.

    Now, could there be any better arguement for precribers "having no financial interest?"

    Chip

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    Quote Originally Posted by Uncle Fester
    Twenty plus years ago I worked in Boston and was given an Rx to fill from a well known MD.
    O.D. +0.125 -0.125 x 175
    O.S. +0.125 -0.125 x 177 and a 1/2

    It was the 1/2 degree that had the office rolling on the floor in laughter :)

    Also in those days it wasn't unusual to have hungry OD's in the big city offer "vision training" Rx's; here's another!

    O.U. plano distance with 3 prism degrees Base Up O.U.

    Now before all you experienced Doctors jump down my throat we all know the first Rx is someone who comes into the office convinced they need prescription glasses! So who are we to deny them? From my conversation with the second patient I'm not so sure the Doctor wasn't drumming up business.
    I too have rxs coming in with ou +.50 w/ 1 or 2 bu. its for use with autistic kids and the parents tell me they work. I understand they stimulate the peripheries.

  11. #11
    What's up? drk's Avatar
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    Quote Originally Posted by Uncle Fester
    Twenty plus years ago I worked in Boston and was given an Rx to fill from a well known MD.
    O.D. +0.125 -0.125 x 175
    O.S. +0.125 -0.125 x 177 and a 1/2

    It was the 1/2 degree that had the office rolling on the floor in laughter :)

    Also in those days it wasn't unusual to have hungry OD's in the big city offer "vision training" Rx's; here's another!

    O.U. plano distance with 3 prism degrees Base Up O.U.

    Now before all you experienced Doctors jump down my throat we all know the first Rx is someone who comes into the office convinced they need prescription glasses! So who are we to deny them? From my conversation with the second patient I'm not so sure the Doctor wasn't drumming up business.
    Sad, sad, sad. The yoke prism thing kills me, too. Just say ka--ching.

  12. #12
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Here in VA, those types of statements are against the law, as is placing an expiration date on a spectacle prescription unless medically necessary.

    Quote Originally Posted by harry a saake
    Today a women walked in with an rx from an OD in California, odd thing about it is there is a printed statement on the rx (not handwritten), stating..DISPENSER DO NOT FILL UNLESS PREPARED TO REMAKE FOR PATIENT COMFORT, anybody ever seen this before, sounds nutty to me:hammer:

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    Quote Originally Posted by drk
    Sad, sad, sad. The yoke prism thing kills me, too. Just say ka--ching.
    I think it's sad that the trend on Optiboard is to hastily assume that opticians, optometrists, or ophthalmologists we have never met are simply in it for the money if we disagree with his or her recommendations for treatment, prescriptions, lens options, etc. I am aware that my partner, who is very intersted in vision therapy, has fit at least one patient recently in yoked prisms. Even though I may reserve a bit of skepticism, I have no doubt that she believes in what she does and generates much less money for the practice per hour/minute doing VT than she does doing regular exams.

  14. #14
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    See item D

    PRESCRIPTION RELEASE RULE
    FEDERAL TRADE COMISSION OPTHALMIC PRACTICE RULES PART 456

    Beginning in 1978, when the Federal Trade Commission action known as "Eyeglasses I " was concluded, the subject of prescription release has been widely discussed among opticians, optometrists and ophthalmologists. The Prescription Release Rule protects the interests of eyewear consumers by requiring eye doctors (both optometrists and ophthalmologists) to give the patient an eyeglasses prescription automatically at the conclusion of an examination (assuming the patient needs eyeglasses). The Rule was vigorously opposed by the American Optometric Association, but the Opticians Association of America fought for the Rule and in 1980, the U.S. District Court of Appeals for the District of Columbia upheld OAA's position and the Prescription Release Rule became law. Despite the Rule, however, many eye doctors have refused to give the patient a prescription unless the patient requested it specifically, and often the doctor has placed intimidating and unnecessary warnings or waivers of responsibility on the prescription. Many patients have been required to request the prescription in writing.

    Violator Pays $10,000 Penalty
    Concluding the first case alleging violation of the Prescription Release Rule, a Dallas Texas optometric practice has agreed to pay a $10,000 civil penalty to settle FTC charges that they failed to provide many patients with a copy of their eyeglass prescription after an eye examination and that they unlawfully included on their prescription form a waiver of liability as to accuracy. In addition to paying the penalty, the practice is permanently barred from future violations of the prescription Release Rule and must train its employees in the Rule's requirements. The practice must also make regular reports to FTC which will monitor future compliance.

    Prescription Defined

    A prescription as defined by the FTC Trade Regulation Rule (CFR 456) is:

    the written specifications for ophthalmic lenses which are derived from an eye examination. The prescription shall contain all of the information necessary to permit the buyer to obtain the necessary ophthalmic goods from the seller of his choice. In the case of a prescription for contact lenses, the refractionist must include in the prescription only those measurements and directions which would be included in a prescription for spectacle lenses. All prescriptions shall include all the information specified by state law, if any."

    The Prescription Release Rule mandates the release of the prescription to the patient and prohibits disclaimers or extra fees for the prescription. It is an unfair act or practice for an ophthalmologist or optometrist to:

    A. Fail to provide to the patient one copy of the patient's prescription immediately after the eye examination is completed. Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;

    B. Condition the availability of an eye examination to any person on a requirement that the patient agree to purchase any ophthalmic goods from the ophthalmologist or optometrist;

    C. Charge the patient any fee in addition to the ophthalmologists's or optometrist's examination fee as a condition to releasing the prescription to the patient. Provided: An ophthalmologist or optometrist may charge an additional fee for verifying ophthalmic goods dispensed by another seller when the additional fee is imposed at the time the verification is performed, or

    D. Place on the prescription, or require the patient to sign, or deliver to the patient, a form or notice waiving or disclalming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

  15. #15
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    "Sad, sad, sad. The yoke prism thing kills me, too. Just say ka--ching."


    FYI, yoked prism is utilized quite often for children with autism as well as adults/children that have suffered cerebral vascular accident, traumatic brain injury, or who has had a physical disability from multiple sclerosis or cerebral palsy. The latter group of people have neuro-motor imbalances and the use of yoked prism can help them correct what is termed a visual mid-line shift.

    With regards to low plus and or a combination of low plus with prism Rx's....when I was a practioner some patients would come in very symptomatic both visually and emotionally. The low plus with prism was enough to get their visual system back on track and I would modify their Rx's over the course of a year at cost. Typically these folks had no time for VT. These folks were explained the reason for the RX and appreciated that I had given the necessary time to help them with a problem that previously went untreated.

    Doc

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    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    It is then incumbent upon us all to report infractions to the appropriate authorities, such as state Boards of Medicine or Boards of Optometry. Otherwise the law is toothless and we all become willing victims.

    Quote Originally Posted by CME4SPECS
    D. Place on the prescription, or require the patient to sign, or deliver to the patient, a form or notice waiving or disclalming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

  17. #17
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Sad that it seems autistic or brain injured patients seem according to loved ones to benefit from yoked prisms. Then again who are we to deny them hope? The patient I dealt with (who was cognizant) was surprised at how the prescribing OD was very reluctant to give her the Rx and felt that it should only be filled by his dispensary. Are there any double blind masked studies to bolster yoked prisms benfits? I'd liked to think there are. - Fester
    Last edited by Uncle Fester; 01-26-2005 at 10:41 PM.

  18. #18
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    Quote Originally Posted by Uncle Fester
    Sad that it seems autistic or brain injured patients seem according to loved ones to benefit from yoked prisms.
    Sad? If it seems that they benefit, then that is a good thing.


    Quote Originally Posted by Uncle Fester
    The patient I dealt with (who was cognizant) was surprised at how the prescribing OD was very reluctant to give her the Rx and felt that it should only be filled by his dispensary.
    Not sure exactly what I am to infer from that, other than you may think he was a reluctant crook.


    Quote Originally Posted by Uncle Fester
    Are there any double blind masked studies to bolster yoked prisms benfits? I'd liked to think there are.
    Well, there is good news for you!

    Some studies:
    The use of yoked base-up and base-in prism for reducing eye strain at the computer.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=88 88830

    Behavioral changes in autistic individuals as a result of wearing ambient transitional prism lenses.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=97 35531

    Spatial orientation adjustments in children with autism in Hong Kong.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11 196013

    Postural orientation modifications in autism in response to ambient lenses.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=89 36794

    Vertical yoked prism--patient acceptance and postural adjustment.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=36 84280


    A couple case reports:
    Fixation dysfunction with intermittent saccadic intrusions managed by yoked prisms: a case report.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10 970262

    Duane's retraction syndrome and the relief of secondary torticollis and near point asthenopia with prism.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=23 80474


    An article:
    Vision Disturbances Following Traumatic Brain Injury.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12 036500

  19. #19
    What's up? drk's Avatar
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    Quote Originally Posted by 1968
    I think it's sad that the trend on Optiboard is to hastily assume that opticians, optometrists, or ophthalmologists we have never met are simply in it for the money if we disagree with his or her recommendations for treatment, prescriptions, lens options, etc. I am aware that my partner, who is very intersted in vision therapy, has fit at least one patient recently in yoked prisms. Even though I may reserve a bit of skepticism, I have no doubt that she believes in what she does and generates much less money for the practice per hour/minute doing VT than she does doing regular exams.
    I'm sorry, 1968, I was completely unclear in my post. I meant to say something to the effect of:

    (Optician speaking) "This outside Rx makes no sense to me, but I'm going to make a few bucks, anyway."

  20. #20
    What's up? drk's Avatar
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    Quote Originally Posted by DocInChina
    "Sad, sad, sad. The yoke prism thing kills me, too. Just say ka--ching."


    FYI, yoked prism is utilized quite often for children with autism as well as adults/children that have suffered cerebral vascular accident, traumatic brain injury, or who has had a physical disability from multiple sclerosis or cerebral palsy. The latter group of people have neuro-motor imbalances and the use of yoked prism can help them correct what is termed a visual mid-line shift.

    With regards to low plus and or a combination of low plus with prism Rx's....when I was a practioner some patients would come in very symptomatic both visually and emotionally. The low plus with prism was enough to get their visual system back on track and I would modify their Rx's over the course of a year at cost. Typically these folks had no time for VT. These folks were explained the reason for the RX and appreciated that I had given the necessary time to help them with a problem that previously went untreated.

    Doc
    I'm well aware of that philosophy and behavioral optometry, etc. I just don't want to go into it on Optiboard, since it's not germane. I usually argue about that stuff on Seniordoc.org, where it's flying all the time.

    I should've kept my mouth shut, knowing that behavioral ODs are everywhere!:hammer: Bad judgement on my part to even get the can opener close to that can of worms. I'm outta this thread, forever.

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